2016-05-11T16:33:45-05:00 2015-06-30 300702322 HEMMING MORSE CPA'S AND CONSULTANTS 155 BOVET ROAD SUITE 600 SAN MATEO CA 94402 990 2014-07-01 946434612 WHOLESALE BEER DISTRIBUTORS INDUSTRY TRUST FUND WHOL 6505729611 5776 STONERIDGE MALL ROAD NO 290 PLEASANTON CA 94588 TRUSTEE TRUSTEE TRUSTEE 6505729611 2016-05-11 1 P00739466 4158364000 2014 2016-08-17 19:52:53Z 5776 STONERIDGE MALL ROAD NO 290 PLEASANTON CA 94588 18799799 0 X N/A X 1981 CA SEE (A) BELOW 4 4 0 0 0 0 0 0 17143263 18212298 23670 32037 118781 555464 17285714 18799799 0 0 14752981 16790710 0 0 0 0 0 963078 1096501 15716059 17887211 1569655 912588 5350278 6325138 1935284 2024611 3414994 4300527 NONE 0 0 TO PROVIDE HEALTH CARE BENEFITS TO ELIGIBLE PARTICIPANTS COVERED UNDER THE COLLECTIVE BARGAINING AGREEMENT BETWEEN THE UNION AND EMPLOYERS AND NON-UNION EMPLOYER AGREEMENTS WITH THE TRUST 0 0 0 0 0 0 0 0 0 0 0 0 1 1 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 X 4 4 0 0 0 0 0 0 0 1 0 0 0 1 0 0 0 0 0 0 X PREFERRED BENEFIT INSURANCE ADMIN 6505729611 5776 STONERIDGE MALL ROAD SUITE 290 PLEASANTON CA 94588 X CES BUTNER TRUSTEE 5.00 X 0 0 0 PATRICK LAWING TRUSTEE 5.00 X 0 0 0 CATHERINE FOX TRUSTEE 5.00 X 0 0 0 DAVE BOTTOMLEY TRUSTEE 5.00 X 0 0 0 0 0 0 0 0 0 0 ANTHEM BLUE CROSS PO BOX 60007 LOS ANGELES CA 90060 CLAIMS ADMINISTRATION 281079 HSBA 4160 DUBLIN BLVD SUITE 400 DUBLIN CA 94568 CLAIMS PROCESSING 141086 ANDREINI & CO 220 WEST 20TH AVENUE SAN MATEO CA 94403 CONSULTANT 135331 PREFERRED BENEFIT INSURANCE ADMINISTRATO 3 WATER PARK DR SUITE 225 SAN MATEO CA 94403 THIRD PARTY ADMINISTRATOR 129949 4 EMPLOYER CONTRIBUTIONS 900099 18212298 18212298 18212298 32037 32037 INSURANCE REFUNDS 900099 555464 555464 555464 18799799 18767762 0 32037 16790710 873699 13047 35620 12972 12220 TRANSITIONAL REINSURANC 82966 CONSULTANT 33600 HSBA 12335 MEETING EXPENSE 7645 12397 17887211 3185225 3503628 15500 15301 937800 646889 1203951 1709132 7802 450188 5350278 6325138 76773 71045 1858511 1953566 1935284 2024611 X 0 0 0 0 3414994 4300527 3414994 4300527 5350278 6325138 912588 -27055 0 X X 0 1 X 1 0 0 EXEC-U-CARE REIMBURSEMENTS 188 STOP LOSS REIMBURSEMENTS 450000 450188 GROUP INSURANCE PREMIUMS PAYABLE 453616 SELF-FUNDED BENEFIT CLAIMS PAYABLE 235793 INCURRED BUT NOT REPORTED CLAIMS 1264157 1953566 18772744 -27055 -27055 18799799 0 18799799 17887211 0 17887211 0 17887211 FORM 990, PART VI, SECTION A, LINE 8B THERE ARE NO COMMITTEE'S WITH AUTHORITY TO ACT ON BEHALF OF THE GOVERNING BODY. FORM 990, PART VI, SECTION B, LINE 11 THE TRUSTEES DESIGNATE THE ADMINISTRATOR TO REVIEW THE FORM. FORM 990, PART VI, SECTION C, LINE 19 THE ORGANIZATION DOES NOT MAKE ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, OR FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC. FORM 990, PART XI, LINE 2C THE BOARD OF TRUSTEES ASSUMES RESPONSIBILITY FOR OVERSIGHT OF THE AUDIT OF THE PLAN'S FINANCIAL STATEMENTS AND SELECTION OF THE INDEPENDENT AUDITOR. VARIOUS - SEE SUPPLEMENTAL SCHEDULE VARIOUS - SEE SUPPLEMENTAL SCHEDULE 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 FORM 990, PART IV, LINE 24 SCHEDULE R, IDENTIFICATION OF RELATED ORGANIZATIONS: THE FILING ENTITY IS A 501(C)(9) VEBA WHO MUST LIST CONTRIBUTING EMPLOYERS ON SCHEDULE R. THE ADMINISTRATIVE OFFICE MAINTAINS A LIST OF CONTRIBUTING EMPLOYERS, HOWEVER, THAT LIST DOES NOT INCLUDE FEDERAL TAX CLASSIFICATION. THEREFORE, THE LIST OF CONTRIBUTING EMPLOYERS IS REPORTED ON PART VII, SUPPLEMENTAL INFORMATION. MATAGRANO, INC. ADVANCE BEVERAGE ANHUESER-BUSCH - OAKLAND BOTTOMLEY DISTRIBUTING FOOTHILL DISTRIBUTING ALLIED BEVERAGES, INC. CENTRAL COAST DISTRIBUTIN REDDING DISTRIBUTING COMP MORRIS DISTRIBUTING BAY AREA DISTRIBUTING CO. ALFORD DISTRIBUTING ANHUESER-BUSCH - SAN JOSE CLAYPOOL DISTRIBUTING COM HIGH SIERRA DISTRIBUTING SUPERIOR PRODUCTS COMPANY MT. SHASTA BOTTLING & DIS HORIZON BEVERAGE GILLESPIE DIST. CO., INC. EASTERN SIERRA WHOLESALER WONDERLAND DISTRIBUTING C PACIFIC HEALTH ALLIANCE BENITES DISTRIBUTING CO. SUPERIOR PRODUCTS MOUNTAI M. E. FOX AND COMPANY, IN BEVHAUL LOGISTICS HL & S TRUCKING CO., INC. BLACK DIAMOND BREWING COM ALDRIDGE & COMPANY HANNEY ASSOCIATES